Journal Club

When to perform CTA in patients suspected
of PE?

Conclusion

Strict adherence to management guidelines is mandatory,
as appropriateness of diagnostic strategy and criteria
strongly correlate with patient outcome. Inappropriate
management can increase up to a sixfold recurrence of
VTE [83]. The first goal of a diagnostic strategy is to
exclude VTE in as many patients as possible. This can be
achieved by combination of low clinical probability and
normal D-dimer test (probably also in intermediate clinical
probability with negative ELISA D-dimer test), or a normal
perfusion lung scan. The second step is to confirm the
diagnosis of VTE using a simple and reliable test, a role
devoted to MD-CTPA [6]. Studies focusing on inpatients
are still needed.


Journal Title - European Radiology
Article Title - When to perform CTA in patients suspected of PE?
Volume - Volume 18
Issue - 3
First Page - 500
Last Page - 509
Issue Cover Date - 2008-03-09

Author - Benoît Ghaye
Author - Robert F. DondelingerDOI - 10.1007/s00330-007-0768-x
Link - http://www.springerlink.com/content/y824mm218u398083

E assim terminou mais um RSNA

O congresso científico e a reunião anual da sociedade radiologica da America do Norte (RSNA) são a reunião médica internacional maior do mundo.

Os factos sobre a reunião incluem:

Seis dias de programas educacionais para radiologistas, radioterapeutas, físicos da imagem e profissionais aliados aos cuidado de saúde;

O registo profissional foi 2% acima comparado com o 2004.

Os participantes ocuparam 22.324 quartos do hotel na noite mais alta, em 67 hotéis de Chicago.

Os participantes contribuiram quase $112 milhões à economia de Chicago

Foram afectuados 2.072 apresentações e posteres que cobrem 16 subespecialidades: tórax; cardiaco; emergência; gastrointestinal; genitourinario; serviços, política e pesquisa de saúde; musculoesquelético; neuroradiologia/cabeça e pescoço; medicina nuclear; pediatria; física; oncologia e radiobiologia da radiação; radiologia e informática; ecografia; vascular e intervenção. Houve 299 cursos de refrescamento e uma área da exibição do infoRAD com 150 exibições e mais de 50 classes tutoriais.

Blog Rad no RSNA

Aqui fica uma foto do Blog Rad no RSNA, o maior congresso de Radiologia do Mundo, com mais de 70.000 participantes.

Journal Club

Finalmente um artigo que vem trazer alguma luz sobre o problema dos nódulos pulmonares?

(Radiology 2005;237:395-400.)
© RSNA, 2005

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Editorials

Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society1
Heber MacMahon, MB, BCh, BAO, John H. M. Austin, MD, Gordon Gamsu, MD, Christian J. Herold, MD, James R. Jett, MD, David P. Naidich, MD, Edward F. Patz, Jr, MD and Stephen J. Swensen, MD
1 From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC2026, Chicago, IL 60637 (H.M.); Department of Radiology, Columbia University Medical Center, New York, NY (J.H.M.A.); Department of Radiology, New York Hospital, Cornell Medical Center, New York, NY (G.G.); Department of Radiology, University of Vienna Medical School, Vienna, Austria (C.J.H.); Departments of Medicine (J.R.J.) and Diagnostic Radiology (S.J.S.), Mayo Clinic College of Medicine, Rochester, Minn; Department of Radiology, NYU Medical Center, New York, NY (D.P.N.); and Department of Radiology, Duke University Medical Center, Durham, NC (E.F.P.). Received November 5, 2004; revision requested January 5, 2005; revision received March 3; accepted May 2. Address correspondence to H.M. (e-mail: macm@midway.uchicago.edu).

Lung nodules are detected very commonly on computed tomographic (CT) scans of the chest, and the ability to detect very small nodules improves with each new generation of CT scanner. In reported studies, up to 51% of smokers aged 50 years or older have pulmonary nodules on CT scans. However, the existing guidelines for follow-up and management of noncalcified nodules detected on nonscreening CT scans were developed before widespread use of multi–detector row CT and still indicate that every indeterminate nodule should be followed with serial CT for a minimum of 2 years. This policy, which requires large numbers of studies to be performed at considerable expense and with substantial radiation exposure for the affected population, has not proved to be beneficial or cost-effective. During the past 5 years, new information regarding prevalence, biologic characteristics, and growth rates of small lung cancers has become available; thus, the authors believe that the time-honored requirement to follow every small indeterminate nodule with serial CT should be revised. In this statement, which has been approved by the Fleischner Society, the pertinent data are reviewed, the authors' conclusions are summarized, and new guidelines are proposed for follow-up and management of small pulmonary nodules detected on CT scans.

© RSNA, 2005

Journal Club

In patients with no or moderate coronary calcification, 16-slice MDCT allows the reliable detection of coronary artery stenosis with high diagnostic accuracy, say researchers from Tuebingen University Hospital in Germany. Coronary artery stenosis is the narrowing of coronary arteries due to the build-up of calcified plaques.

The study included 37 patients, 28 of whom had a calcium score of less than 1,000 (no calcification to moderate calcification). The researchers found that 16-MDCT was very accurate in diagnosing these patients, having a sensitivity and specificity of 93% and 94%, respectively.

When the remaining nine who had a calcium score of 1,000 or greater (severe calcification) were added, the overall sensitivity and specificity dropped to 59% and 87%, respectively. “Severe coronary calcification reduces reliable visualization of the coronary arteries and may mask vascular stenosis, but 16-MDCT has improved the visualization of coronary arteries so that those with no or moderate coronary calcification can be diagnosed accurately,” said Martin Heuschmid, MD, lead author of the study.

According to the researchers, coronary artery lesions are usually diagnosed by coronary angiography. “Coronary angiography, though, is an invasive examination with certain risks for the patients. MDCT could help to circumvent those drawbacks. However, in patients with severe coronary calcification, conventional coronary angiography may still be necessary to diagnose or exclude high-grade stenosis of the coronary tree,” said Dr. Heuschmid.

The study appears in the May 2005 issue of the American Journal of Roentgenology.

AJR May 2005;184:1413-1419